Gastroenterology Flashcards
(48 cards)
If a patient has tried PPIs for dyspepsia and they have nit nessisarily work what should the next approach / treatment?
Test for H. pylori (e.g. stool)
If oral Vancomycin does not work for treatment of C. diff what is the next treatment?
Oral fidaxomicin
What is the mainstay of treatment for bowel obstruction (3)
- NG tube insertion
- Catheterisation
- IV fluid resuscitation
What drugs should be avoided in bowel obstruction?
Laxatives and anti-emetics with pro-kinetic properties (e.g metoclopramide) - can precipitate perforation
How long after diarrhoea has stopped do patients with C.diff need to be isolated for?
48 hrs
What are the triad of symptoms in Budd-Chiari? (3)
- What other important aspect should you look for in the patient’s history? (1)
- Sudden onset abdo pain
- Ascites
- Tender hepatomegaly
- History of clotting/FH/ clotting disorder (e.g factor V leiden)
What are the complications of constipation (3)
- Overflow diarrhoea
- Acute urinary retention
- Haemorroids
What is the 1st line drug management of constipation? (class of drug + example)
Bulk forming laxative (e.g. Ispaghula)
What is the 2nd line drug management of constipation? (class of drug + example)
Osmotic laxative (e.g. Macrogol)
What is the best screening investigation for haemochromatosis?
Transferrin saturation (iron studies and ferritin also useful)
How can Family members of haemochromatosis be screened?
Genetic testing: HFE gene
What should the transferrin saturation and serum ferritin concentration be kept below?
- Transferrin sat: <50%
- Serum ferritin: <50 ug/L
What is the management of PBC? (3)
- final line as well (1)
- Ursodeoxycholic acid
- Cholestyramine for pruritis
- Vitamins (fat soluble) supplementation
- Liver transplant final line
Coeliac disease is associated with the development of what cancer?
T cell lymphoma (enteropathy-associated T cell lymphoma of SI)
Vomiting + severe chest pain and shock is likely what syndrome?
Boerhaave syndrome
What is Courvoisier’s law?
Painless obstuctive jaundice and a palpable non-tender gallbladder is unlikely gallstones
- Pancreatice malignancy most likely
What is the 1st and 2nd line treatment of hepatic encephalopathy?
- Bonus points for MOA
- Lactulose (excretion + incr metabolism of gut flora)
- Rifaximin (antiB that modulates gut flora resulting in decreased ammonia production)
What autoantibody may be +ve in PSC
p-ANCA
Ascites conservative management options?
- Reduce dietary sodium
- Fluid restriction if sodium < 125 mmol/L
What prophylactic antiBs may be used in Ascites to prevent SBP?
Oral Ciprofloxacin or Norfloxacin
What treatment may be offered in tense ascites?
Large-volume paracentesis (may require albumin cover)
- Also TIPS
What lab investigation caan be used to differentate mild moderate and severe (not life-threatening though) C diff
WCC
- Normal, <15x10^9, > 15x10^9
How is diagnosis of C diff made?
Detecting C diff toxin in stool
- Not the antigen
Prophylaxis of oesophageal bleeding
Propranolol
